Complex Adaptive System
In the effort to create a successful environment that supports information and idea exchange among our diverse and autonomous members, IDND is guided by a main theoretical framework, known as a complex adaptive system.
A complex adaptive system is an open, dynamic and flexible network that is considered complex due to its composition of numerous interconnected, semi-autonomous competing and collaborating members. This system is capable of learning from its prior experiences and is flexible to change in the connecting pattern of its members in order to fit better with its environment.
Complex adaptive systems are characterized by emergent behaviors as opposed to predetermined ones and self-organized controls instead of hierarchical or central controls. The weather, the stock market, and the health care system are examples of complex adaptive systems. The healthcare system is composed of autonomous individuals that are working hard on providing care for their patients. These individuals interact constantly in a nonlinear way and are continually faced with external and internal changes such as patient’s medical status, insurance requirements, regulations, new research findings, members’ turnover and legal issues.
Traditional organizational theory leads us to view healthcare systems as machine-like with replaceable parts and behaviors that could be predicted and replicated based on past performance data. This view assumes that stability is the natural state of these systems; that systems consist of functions and roles that are carried out by replaceable employees; and that financial incentives, regulatory policies, detailed inflexible protocols, and best practice initiatives are the only recipes for introducing a change to these systems.
Prior research shows that such standardized protocols are typically not feasible, replicable, or effective due to the unique local interactions of patients, employees, resources, and other demands faced by these complex adaptive systems. Recognizing the properties of complex adaptive systems, it becomes apparent why many previous efforts in building research processes within these systems have been unsuccessful and why scientific evidence alone does not necessarily predict adoption of new innovations.
While this new understanding may be intuitively attractive, a strategy is needed that incorporates complexity. There are many published strategies to help manage organizational change, but the strategy IDND has chosen to implement is the reflective adaptive process (RAP) developed by the NIH.
Reflective Adaptive Process
The reflective adaptive process is a practical method for using complex adaptive system principles to introduce acceptable, locally matched, and effective change in a health care system.
RAP facilitates the development of strategies, not prescribed protocols, and change built on explicit opportunities for learning, reflection, and adaptation. This process also encourages practice members to think and act like a team. Building on these principles, we chose to incorporate the reflective adaptive process (RAP) as a practical method focused on using complex adaptive system principles to introduce acceptable and effective change.
The guiding principles of RAP are:
- Vision, mission, and shared values (Standardized Minimum Care)
- Time and space for learning and reflection ($$$)
- Tension and discomfort are essential!
- Diverse Improvement teams
- Supportive leadership
- Effective and timely feedback system
To implement change, we suggest the following approach:
- Select overall content that is based on a systematic evidence review of past research or guidelines.
- Develop a Reflective Adaptive Process implementation team to:
- Localize the content.
- Localize and or invent the delivery process.
- Monitor the delivery process.
- Monitor the system members’ interactions.
- Detect emergent behaviors.
- Evaluate the impact of the selected change.
- Provide immediate performance feedback.
Consultancy Style Meetings
Every other month, IDND holds meetings with two main purposes. The first goal of our bimonthly meetings is to connect members to one another through networking and open discussion. The second goal is to come up with solutions to problems or proposals within the dementia community. These may pertain to topics such as dementia care or dementia research.
In order to accomplish our second goal, we follow a structure known as the consultancy model , developed by the Hartford Foundation.
A consultancy is a group problem-solving activity that is structured to enable a set of people with a variety of knowledge and expertise to provide support, new perspectives, and ideas to one another, particularly around an important or difficult challenge.
The consultancy model follows strict guidelines that are proven to help enable problem solving.
- The presenter has has up to 15 minutes to present his or her selected challenge through a typical oral presentation with or without the help of PowerPoint.
- All the meeting attendants have up to 10 minutes to ask clarifying questions related to the presented challenge.
- Each attendant has up to 5 minutes to provide feedback to the presenter.
- The presenter has up to 5 minutes to summarize the feedback received.
- The presenter must master the art of listening with no argument or response to the suggestions of the IDND members.
- Following the feedback summary, the group will have an open space discussion regarding the themes generated from the consultancy round.